Variability in state Medicaid medication management initiatives

Testing the organizational theory of innovation implementation effectiveness in a community pharmacy medication management program: a hurdle regression analysis

“…This small subset of beneficiaries is disproportionately impacted by chronic conditions, such as diabetes and asthma, and the co-occurrence of difficult-to-treat conditions (e.g., substance use and mental health conditions) [ 3 ]. To improve chronic disease management, several Medicaid programs have implemented medication management programs in partnership with pharmacists [ 4 – 6 ].…”

“…Pharmacist-led medication management programs have improved patients’ medication adherence and therapeutic outcomes (e.g., blood pressure, hemoglobin A1C) while reducing healthcare costs [ 7 – 10 ]. However, researchers have had difficulty attributing changes in patient outcomes to specific program features due to the wide variability in medication management programs [ 4 , 11 ]. In the Medicare Part D Medication Therapy Management (MTM) program, for example, researchers have noted that medication services are delivered in a variety of settings (e.g., call centers, outpatient care) and formats (e.g., in-person vs. phone) [ 11 ].…”

“…In the Medicare Part D Medication Therapy Management (MTM) program, for example, researchers have noted that medication services are delivered in a variety of settings (e.g., call centers, outpatient care) and formats (e.g., in-person vs. phone) [ 11 ]. Similar challenges exist in Medicaid medication management programs—programs vary in patient eligibility criteria, the services provided, and the setting of service delivery [ 4 ].…”

In Patient Safety Efforts, Pharmacists Gain New Prominence

“…One key obstacle is the lack of payment mechanisms that explicitly provide for pharmacist services. 13 Currently, pharmacists are not recognized by Medicare with "provider status," which limits their ability to be reimbursed for services delivered. 3 This has brought pharmacists to a gray area within ACOs, where the role of the pharmacist remains undefined.…”

“…3 A small number of practices may have contractual arrangements with commercial payers for pharmacist services, and several states now have a system in place whereby Medicaid covers pharmacist services for medication management. 13 A physician's familiarity and experience with collaborative practice agreements 14 -formal practice relationships between pharmacists and prescribers-can influence their ideas on how to have a close working relationship with pharmacists.…”